airway dwi
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M Dwi Satriyanto.
Department of Anesthesiology
Padjadjaran University, Hasan Sadikin Hospital
Bandng
A!"#A$ MA%A&'M'%(A!"#A$ MA%A&'M'%(
#hen yo )an*t +reath, nothing else matters#hen yo )an*t +reath, nothing else matters
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'sta+lishing A Patent Airway'sta+lishing A Patent Airway
Head tilt,Head tilt, -hin ift and /aw (hrst Manever-hin ift and /aw (hrst Manever
0ropharyngeal Airway0ropharyngeal Airway
%asopharyngeal Airway%asopharyngeal Airway
aryngeal Mask Airwayaryngeal Mask Airway
11(he a+ove do not prote)t against aspiration and(he a+ove do not prote)t against aspiration and
laryngospasmlaryngospasm
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Mask 2entilationMask 2entilation
-an Deliver A High 3!04-an Deliver A High 3!04
Avoids (he Potential (rama 0fAvoids (he Potential (rama 0f
!nt+ation!nt+ation
Does %ot Prote)t Against AspirationDoes %ot Prote)t Against Aspiration
May "eslt !n &astri) DistensionMay "eslt !n &astri) Distension
aryngospasm -an 0))raryngospasm -an 0))r
"e5ires Use 0f Both Hands"e5ires Use 0f Both Hands
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0ral6%asal !nt+ation0ral6%asal !nt+ation
Safe and -ommon Pra)ti)e in PatientsSafe and -ommon Pra)ti)e in Patients
Undergoing &eneral AnesthesiaUndergoing &eneral Anesthesia
Atramati) !nt+ation re5ires 7nowledge ofAtramati) !nt+ation re5ires 7nowledge of
Anatomy, Appropriate se of '5ipment, andAnatomy, Appropriate se of '5ipment, andDrgs 8Ms)le "ela9ants:Drgs 8Ms)le "ela9ants:
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Preoperative 'valationPreoperative 'valation
Patient HistoryPatient History
11 Prior History of Diffi)lt !nt+ationPrior History of Diffi)lt !nt+ation
11 (mor of Head and %e)k(mor of Head and %e)k
11 ArthritisArthritis
11 Pregnan)yPregnan)y
11 (rama 1 - Spine, 3ll Stoma)h(rama 1 - Spine, 3ll Stoma)h
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Preoperative 'valationPreoperative 'valation
Physi)al '9aminationPhysi)al '9amination
11 (onge verss Pharyngeal Si;e(onge verss Pharyngeal Si;e
11 Atlanto 1 0))ipital /oint '9tensionAtlanto 1 0))ipital /oint '9tension
-ervi)al Spine Mo+ility 8normal )m
11 Dental '9amination 8oose (eeth, Prostheses:Dental '9amination 8oose (eeth, Prostheses:
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(e)hni5e 3or 0rotra)heal !nt+ation(e)hni5e 3or 0rotra)heal !nt+ation
Preparation And '5ipment 8Always HavePreparation And '5ipment 8Always HaveS)tion Availa+le:S)tion Availa+le:
Head Position 1 Alignment 0f 0ral, Pharyngeal,Head Position 1 Alignment 0f 0ral, Pharyngeal,
and aryngeal A9esand aryngeal A9es -hoi)e 0f aryngos)ope And 'ndotra)heal (+e-hoi)e 0f aryngos)ope And 'ndotra)heal (+e
Possi+le %eed 3or Awake (ra)heal !nt+ationPossi+le %eed 3or Awake (ra)heal !nt+ation
11 Diffi)lt Airway AlgorithmDiffi)lt Airway Algorithm
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S ? S)ope 8aringoskop @ Stetoskop:
( ? (+e 8pipa jalan napas:
A ? Airway 8 Mayo:
( ? (ape 8plester:
! ? !ntrod)er 8Maindrain:
- ? -one)tor
S ? S)tion
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0rotra)heal !nt+ation0rotra)heal !nt+ation
Patient*s Head At (he evel 0f (he iphoidPatient*s Head At (he evel 0f (he iphoid
Sniffing PositionSniffing Position
aryngos)ope !naryngos)ope !n LEFTLEFTHandHand
0pen Moth0pen Moth
Hold (ra)heal (+e !n "ight Hand ike A Pen)ilHold (ra)heal (+e !n "ight Hand ike A Pen)il
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li i f h l
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-ompli)ations 0f 0rotra)heal-ompli)ations 0f 0rotra)heal
!nt+ation 8Dring:!nt+ation 8Dring:
Dental And 0ral Soft tisse (ramaDental And 0ral Soft tisse (rama
Hypertension And (a)hy)ardiaHypertension And (a)hy)ardia
-ardia) Dysrhythmias And Myo)ardial !s)hemia-ardia) Dysrhythmias And Myo)ardial !s)hemia
AspirationAspiration
-orneal Damage-orneal Damage
li i f h l- li i 0f 0 h l
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-ompli)ations 0f 0rotra)heal-ompli)ations 0f 0rotra)heal
!nt+ation 8!nt+ated Patient:!nt+ation 8!nt+ated Patient:
(ra)heal (+e 0+str)tion(ra)heal (+e 0+str)tion
'ndo+ron)hial !nt+ation'ndo+ron)hial !nt+ation
BarotramaBarotrama A))idental Dis)onne)tA))idental Dis)onne)t
(ra)heal M)osa !s)hemia(ra)heal M)osa !s)hemia
A))idental '9t+ationA))idental '9t+ation
! di A d d l d! di A d d l d
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!mmediate And delayed!mmediate And delayed
-ompli)ations 0n '9t+ation-ompli)ations 0n '9t+ation
aryngospasmaryngospasm
AspirationAspiration
PharyngitisPharyngitis aryngeal 0r S+glotti) 'demaaryngeal 0r S+glotti) 'dema
2o)al -ord Paralysis2o)al -ord Paralysis
Arytenoid -artilage Dislo)ationArytenoid -artilage Dislo)ation
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Alternatives (o 0rotra)healAlternatives (o 0rotra)heal
!nt+ation Under Anesthesia!nt+ation Under Anesthesia
Awake 0rotra)heal !nt+ationAwake 0rotra)heal !nt+ation
%asotra)heal !nt+ation%asotra)heal !nt+ation
11 Awake Blind %asalAwake Blind %asal11 %asotra)heal !nt+ation After !nd)tion%asotra)heal !nt+ation After !nd)tion
!nt+ation #ith 3i+eropti) Bron)hos)ope!nt+ation #ith 3i+eropti) Bron)hos)ope
11 Awake verss Under AnesthesiaAwake verss Under Anesthesia
11 0rotra)heal verss %asotra)heal0rotra)heal verss %asotra)heal "etrograde !nt+ation"etrograde !nt+ation
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2erifi)ation 0f -orre)t (+e Pla)ement2erifi)ation 0f -orre)t (+e Pla)ement
Symmetri) -hest MovementSymmetri) -hest Movement
Symmetri) Breath SondsSymmetri) Breath Sonds
'nd tidal -ar+on Dio9ide'nd tidal -ar+on Dio9ide
11 &reater (han
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-on)lsion-on)lsion
Airway management is an e9tremely important aspe)t ofAirway management is an e9tremely important aspe)t of
the pra)ti)e of anesthesiology and )riti)al )arethe pra)ti)e of anesthesiology and )riti)al )are
A firm +asis in airway anatomy is neededA firm +asis in airway anatomy is needed
Skills s)h as mask ventilation, endotra)heal int+ation,Skills s)h as mask ventilation, endotra)heal int+ation,MA pla)ement are ne)essaryMA pla)ement are ne)essary
!n the )ase of a diffi)lt airway, a logi)al algorithm and!n the )ase of a diffi)lt airway, a logi)al algorithm and
airway e5ipment assist the physi)ian in safely managingairway e5ipment assist the physi)ian in safely managing
the sitationthe sitation
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(hank $o(hank $o
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